Ear, Nose and Throat - U.S.A.  (ENT USA) Ear Pain & Discomfort
Ear Pain & Discomfort
Ear Pain & Discomfort


   Ear pain and discomfort is a very common problem.  However, not all ear pain and discomfort comes from the ear.  Over 50% of ear pain comes from a different area.  This is called "referred pain" or "referred discomfort".  An example of this is an ice cream headache.  When one swallows cold ice cream the back of the throat is cooled and this produces "referred pain" to the forehead.  Referred ear pain can come from jaw joint (k) spine disease or even sinusitis.  Only a medical examination of the ear and other head and neck areas can determine the exact cause of the ear discomfort.

chronic_otitis_externa.jpg (28357 bytes)Ear Itching
is a common complaint.  It is often associated with dry ear canals and absent ear wax.  Medically, this condition is called Chronic Otitis Externa.  This condition is often caused by an allergy to fungus.  The ear canal is a warm, dark, damp place and fungus often grows there. Antibiotics are ineffective and the condition has been known to last for years.  Over the counter medicines, lotrimin and tinactin solution used two to four times a day, can be helpful.  However, the best treatment I have found is filling the ear canal with an anti-fungal cream. 


Painting the ear canal with gentian violet dye is also effective but this dye should not get into the
middle ear because of possible ototoxicity.   The dye also stains and thus one must be careful in its application.  The ear must also be cleaned by an Ear Doctor. Treatment may last for months and relapses are common.  The capability of the ear to make wax often does not return and this may predispose to the recurrences.   In general dyes and acid mixtures (antiseptics) should not be allowed to get into the middle ear.
The round window as access route for agents injurious to the inner ear.
Am J Otolaryngology, 1988 Nov-Dec;9(6):327-35
Spandow O, Anniko M, Moller AR.

Ototoxicity of common topical antimycotic preparations.
Laryngoscope, 2000 Apr;110(4):509-16.
Tom LW.

Acute Otitis Externa This is an infection of the ear canal.  It is very painful.  There is also pain when one touches the auricle or outer ear.  Unfortunately, this condition is usually caused by a bacteria known as pseudomonas.  Oral antibiotics are usually not effective.  Ear drops must be used and the ear canal must be opened and if possible cleaned.  Opening of the ear canal is accomplished by placing an ear wick into the ear.  This allows the ear drops to enter the ear canal and treat the infection.  Not treated, acute otitis externa can be dangerous.  This is especially true in diabetics where it can spread and cause an infection of the soft tissues of the base of the skull called Malignant Otitis Externa.

Acute otitis externa is often caused by getting water in the ear or sweating in the hot sun.  Keeping the ears dry is important.  Uses a hair dryer if possible.  Never place anything in the ear.  A solution of 1 part white vingear (5% acetic acid) mixed with 3 parts water is often helpful in preventing this disorder.

Ear Wax:  Never stick anything in the ear to remove ear wax.  Q-Tips will push most of the wax further into the ear, making removal more difficult.  There are a number of over-the-counter solutions available to remove ear wax.  If these fail,  consult your physician.

Ear Pressure:  Most ear pressure is caused by a blockage of airflow between the middle ear and the back of the nose.  It can also be a referred sensation from the sinuses.  Patients often have allergic rhinitis (an allergic nose) or sinusitis.

EarOtitisMedia2.jpg (9596 bytes)Acute Otitis Media This is a bacterial infection of the middle ear (the space behind the eardrum).  This infection is one of the most common reason for children to visit the ear doctor.  Unfortunately, the bacterial which cause this infection are becoming more resistant to antibiotics.  Prevnar, a new vaccine, shows promise in reducing the frequency of acute otitis media.  Left untreated, most cases of otitis media will clear with out antibiotics, but 1 in 400 will progress to acute coalescent mastoiditis, a life threatening ear infection; and rarely meningitis, a life threatening brain infection, can occur.  ***Learn More About Acute Coalescent Mastoiditis*** 

Ear Drainage:  This is often a symptom of infection that the eardrum has ruptured.  Treatment with both ear drops and oral antibiotics is indicated.  In a child with ear tubes, the ear infection is often caused by water getting into the ear canal.  In this case, the infection may be caused by pseudomonas and treatment with ear drops is strongly recommended..

Cholesteoma31.jpg (9737 bytes)Cholesteatoma:  This is a skin cyst which forms from the action of middle ear negative pressure on the eardrum.  The skin cyst erodes bone and becomes chronically infected.  If left untreated, it can eroded into the brain (causing meningitis or a brain abscess), ear (causing deafness and dizziness) and facial nerve (causing facial paralysis).  Treatment is imperative for all but the very small or stable cysts in high risk or elderly patients.  Surgery is required and a "mastoidectomy" operation often needs to be performed.



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